Sexual abuse in childhood is a traumatic and damaging experience that can have a range of effects for young people as they grow and develop. These can include increased risk of mental health difficulties such as depression and anxiety, psychological symptoms such as low self-esteem and guilt, and problem behaviours such as substance misuse (Avery, Massat & Lundy, 2000; Cotgrove & Kolvin, 1994; Haggerry Sherwood, Garmezy & Rutter, 1996; Mental Health Foundation, 1999; Richardson & Joughin, 2000). A range of research has assessed the impact of sexual abuse and interventions which have been used to help protect against or alleviate resulting symptoms (Finkelhor & Berliner, 1995; Monck et al., 1996; Stevenson, 1999). Central to many of these studies has been the finding that involving the non-abusing parents of sexually abused children in any treatment approach greatly improves outcomes (Deblinger & Heflin 1996; Finkelhor & Berliner, 1995; Karp, Butler & Bergstrom, 1998). While many sexually abused young people remain in the care of their families, a significant number will be placed in substitute care settings. In such settings, opportunities for treatment may be influenced by a greater range of factors and will likely involve a wider range of professionals with less input from family members (Farmer & Pollock, 1998).
Research has suggested that not only are the opportunities for treatment and support of sexually abused young people restricted in residential child care settings, but that residential settings themselves can often be a context for sexually abused young people becoming re-victimised and further traumatised (Brogi & Bagley, 1998; Farmer & Pollock, 1998; Green & Masson, 2002; Lindsay, 1999). In comparing sexually abused and sexually abusing young people to others in substitute care, Farmer and Pollock state that `sexually abused and abusing children are more disadvantaged than others in state care' (Farmer & Pollock, 1998, p. 129).
This claim may seem bold indeed, given the diverse mix of young people in most residential settings (Berridge & Brodie, 1998; Kendrick, Milligan & , Furnivall, 2004). A close examination of policy reports relating to residential childcare shows, however, that there has been an awareness of the plight of sexually abused young people in substitute care for some time. The Skinner Report (1992), the Utting Report (1997) and the Edinburgh Enquiry (Marshall, Jamieson & Finlayson, 1999) all recommend that the safety and needs of sexually abused young people in residential care should be recognised and prioritised by residential services, and that sexually abused young people should not be placed alongside sexually abusing young people.
More recently the Scottish Needs Assessment Programme (SNAP), a Child and Adolescent Mental Health needs assessment, identified a real gap in provision for sexually abused young people who are looked after in residential settings. The report identifies that residential and health services must take a closer look at joint provision for this group (Public Health Institute of Scotland, 2003). Health services have begun to respond to these recommendations by introducing dedicated health projects for looked after children (Kendrick et al., 2004; Residential Care Health Project, 2004; van Beinum, Martin & Bonnett, 2002).
As a residential social worker, I found that the available research seemed to confirm many of the challenges and difficulties my colleagues and I encountered in working with sexually abused young people. These include: risks of revictimisation; difficulty accessing specialist services; and difficulty managing some of the distressed behaviours exhibited by this vulnerable group of young people (Brogi & Bagley, 1998; Fanshawe, 1999; Farmer & Pollock 1998; Lindsay, 1999; Mistral & Evans, 2002).
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